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Bulletin of the World Health Organization

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Glaucoma is second leading cause of blindness globally

The urgent need for more public health action to tackle glaucoma is underscored by the work of Swiss ophthalmologist André Mermoud, known as the ‘glaucoma pope’, whose charity Vision for All provides free eye health care for poor patients in India, where it has built and operates an eye hospital, and in central Africa.

Another reason is the reduced
importance of trachoma as a cause of
blindness.

This is due to several factors including
the Global Elimination of Trachoma
Project, which WHO launched with
partner organizations, as well as better
access to health care and information,
and to eye care system development,
and improved data.

In their paper Resnikoff et al. found
that the world population aged 50 years
and over had increased by 30% since
1990. In developed countries, the increase
in people over 50 was 16% but in
developing countries, excluding China,
it was 47%, while in China itself the
increase was 27%.

Ophthalmic experts say angle
closure glaucoma is reaching “epidemic
proportions” in China and other parts
of Asia, but there are few reliable data
from these countries.

Mermoud identified the lack of
trained ophthalmologists as a major
factor limiting the diagnosis and care
of people with glaucoma in developing
countries. In Europe, he said, there is
one ophthalmologist for every 10 000
people; in India, there is one for every
400 000 people; and in Africa, one or
less for every million.

“Within one million people, you
will have 10 000 cataracts every year,
and about 1–2% of people — that is,
between 10 000 and 20 000 — will
have chronic glaucoma. Yet there will
be only one doctor to treat them,”
Mermoud said.

“Even when people do reach a doctor,
they don’t have the money to pay for
medicines and eye drops which they may
need to take for the rest of their lives.
And although surgery to unblock the
channels in the eye would be the ideal
treatment, it does not work so well in
African and Asian patients as in people
of European descent for reasons of rapid
scarring of the tissues,” Mermoud said.

Mermoud is carrying out research
to develop surgical procedures that will
be more effective in people with glaucoma
from Africa and Asia.

His charity has also established
a hospital in the village of Mori, in
Andhra Pradesh, in India, which is now
one of the biggest eye hospitals in the
country. It has two operating theatres
and 50 beds.

Although the hospital was built
only three years ago, it is now well on
the way to being self funding. The
poorest patients are treated free, those
on middle incomes are asked for an affordable contribution and the wealthiest
— who are attracted by state-of-the-art
surgical techniques — pay the most,
thus financing the treatment of those
who pay less or nothing at all.

The hospital also has a bus equipped
as a mobile diagnostic unit. Cataract and
glaucoma are the most common conditions
treated at the hospital; patients
with more complex conditions are referred
to an associated hospital, the L.V.
Prasad Eye Institute in Hyderabad.

Vision for All has also begun working
in the Democratic Republic of the
Congo, in Lubumbashi and in Brazzaville
in Congo, Mermoud said.

To tackle the growing problem of
glaucoma, Mermoud said public health
officials needed to increase the number of
ophthalmologists, particularly in Africa,
and to train those already in place, in
countries such as India, in the diagnosis
and treatment of glaucoma.

More work is needed to make
medicines more affordable and more
resources are needed for research to
develop surgery that will be more ef-
ficient on African and Asian patients,
Mermoud said.